The boring life of Jerod Poore, Crazymeds' Chief Citizen Medical Expert.

Safety in Stupidity

First an update on Crazy Meds: Kit noticed an error with the drug-drug interaction checker that's all over the place. For some idiotic reason I coded the link as a secure (https) connection instead of vanilla http. Maybe it was because you could create an account with your cocktail and check impending changes. As if anyone using Crazy Meds actually does that. It's difficult enough as it is to get 90% of the people on the forum to use that tool at all.

In any event the secure connection works only if you're willing to permanently add an exception regarding POZ's expired SSL certificate. They're the same people. Really. I'll be changing everything to http soon enough. Although I may have to deal with something else first...

Topamax has gone generic, which means I'm on generic topiramate now. Has that been a lot of fun. The switch to generic lamotrigine was simple. Teva good, Dr. Reddy bad. Topiramate isn't so simple. I'm getting aurae some days, other days I'm knocked out as if I've taken too much, and other days are just right. This inconsistency in the bioequivalence between each tablet of the generic and brand Topamax is really fucking with me. Should I ask my pharmacist if they can get the generic from another manufacturer? I can try another if available, but I've heard that this problem is widespread. I just wish I could find some documentation.

The aurae have a common trigger: crossword puzzles. Or anything else that requires logical or any other type of thinking. Woo-hoo, the thinking (noogenic) reflex seizures are back! Trileptal gave me reading seizures, where my left arm would violently straighten out whlist I was reading, usually online. Apparently I had short absence seizures most of my life when working on complex arithmetic and/or logic problems.

I asked the Google and PubMed if there were anything in the literature about crossword puzzle-induced seizures. Google pointed me to an exerpt from The neurological side of neuropsychology - by Richard E. Cytowic - that cited Reflex seizures induced by calculation, card or board games, and spatial tasks: a review of 25 patients and delineation of the epileptic syndrome as including crossword puzzles in the list of seizurogenic activities. Google also found Seizures induced by thinking where crossword puzzles are mentioned in the article but not the abstract.

As for PubMed itself, Reflex epilepsy evoked by decision making: report of a case states that crossword puzzles were used as one of many potential ways to induce seizures. The abstract doesn't make it clear if crossword puzzles did anything. In any event the article is in Italian.

This sucks. Not because I'm a big crossword puzzle fan. I just started doing them as a form of mental calisthenics. I was doing the cryptoquote, as pitifully easy as single-letter substitution codes are, for the same reason. That just isn't going to happen until my doctors and I figure out this mess. Protriptyline lowers one's seizure threshold, and at 50mg a day I'm getting close to the maximum dosage. Like most almost all TCAs protriptyline is metabolized by CYP2D6, and my liver probably squeezes out a drop or two of that stuff every other day. Protriptyline has a 74-hour half-life, yet has to be taken three or four times a day to work. Now I understand why Dr. Stahl paraphrased the Merck Manual regarding Vivactil (protriptyline) and how its complicated pharmacokinetics result in its being rarely prescribed. Anything else with a half-life of three days I poor metabolizer like me could get away with taking every other day.

Add to that I'm taking methylphenidate, which lowers the seizure threshold. Allegedly methylphenidate inhibits the metabolism of TCAs, but that's based on nothing but case reports. Of people taking imipramine who were also taking more than their prescribed amount of Ritalin on a daily basis. The effect has never been reproduced in the lab. Hmmmm...

But I never had a problem prior to switching to generic topiramate. And the combination of methylphenidate and protriptyline is used for all sorts of wacky and/or refractory conditions. That has my name written all over it. Yet with Topamax as a third-tier drug the fight with the insurance company might be too much. An increase in the dosage of topiramate and/or lamotrigine would be easier.

Until then I'm going to have to stay stupid. I tried to pick up on a puzzle I left off and started to get a headache and tingling. It went away after I stopped. Until I started looking up stuff for this post. Again I have an aura with the headache, tingly hands and feet, and my vision is getting a bit funny. Perhaps it's to the point of no return (writing-induced seizure, they're all related), but I think I need to explain my limited presence with periods of total absence for however long it takes to fix. This is may yet be another day I'll to have to write off with lorazepam and too much sleep. I can't remember most of Sunday and on Monday I was so groggy from the extra-strength medication I needed on Sunday I thought it was Friday for most of the day.

For your edification and amusement, some articles on the subject of seizures induced by thinking:

Higher brain function as precipitant of seizure

Self induced noogenic seizures in a photosensitive patient

Reflex writing seizures in two siblings with juvenile myoclonic epilepsy.

Mah-jong epilepsy: a new reflex epilepsy.

Mah-Jong-induced epilepsy: a special reflex epilepsy in Chinese society.

Two examples of Epilepsy Engrish:

Toothbrush-thinking seizures.

Reflex epilepsy evoked by specific psychic activity. A case report.

1 comment:

Dymphna said...

The decision making one - ACK.

My last big nasty was right during a big "should I stay or should I go now..." event.